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Procedural Pain Management Accreditation Standards

The College of Physicians and Surgeons of British Columbia is inviting feedback on the revisions made to the draft procedural pain management (PPM) standards following an initial consultation in 2019. Feedback obtained from physicians during the initial consultation was comprehensive and very beneficial in terms of ensuring the PPM standards outline clear expectations.

Feedback obtained from patients was also useful. Common concerns emerged, including limiting access to PPM in communities and the possibility of having to see a different physician in a new location. These concerns are being considered while collaborative discussions continue with health authorities and the Ministry of Health involving their chronic pain strategy. More information regarding health authorities ensuring access should be available prior to the implementation of the standards in the summer of this year.

Note: This consultation addresses revisions made to the accreditation standards only.

Background

In 2016, the College announced and began an initiative to develop standards for the accreditation of PPM procedures performed outside the hospital setting in community-based physician offices, practices and clinics.

Draft accreditation standards for community-based PPM offices, practices and clinics were developed with an advisory panel of subject-matter experts in pain medicine, anesthesiology (including family practice anesthesia), interventional radiology, and physical medicine and rehabilitation. The draft accreditation standards were posted for a 90-day public consultation period from February 26 through May 27, 2019.

Over 625 responses were received through the consultation process. Approximately 50% of the responses received were from patients; 42% were from physicians; and 8% were from other stakeholder groups such as regulatory/government agencies, caregivers, allied health professionals, Pain BC, the Provincial Health Services Authority department of quality, safety and outcome improvement, the BC Medical Quality Initiative, and the BC College of Family Physicians.

In October 2019, the PPM expert advisory panel was reconvened to review the consultation feedback and provide recommendations for revisions to the draft PPM standards. In November 2019, the NHMSFAP Committee approved the recommended revisions and directed that the revised draft PPM standards be posted for public consultation for a period of 30 days.

Revision highlights

Revisions made following the first consultation period are marked on the draft standards. Highlights include:

Intermediate procedures: The Provincial Infection Control Network (PICNet) has submitted updated recommendations to the Ministry of Health downgrading the reprocessing requirements for external ultrasound probes used for image guidance from high-level disinfection to low-level disinfection. Image guidance for joint injections was also reconsidered and, at this time, image guidance, though strongly recommended, is not mandatory. Therefore intermediate procedures, with the exception of caudal and interlaminar lumbar epidural procedures, have been removed from the list of PPM procedures that would be restricted to accredited facilities.

Advanced cardiac life support (ACLS), airway management and second regulated health professional: The panel reaffirmed its position that physicians performing caudal and interlaminar lumbar epidural procedures, Advanced I and/or Advanced II procedures should hold current ACLS, complete an airway management course and, if the procedure room is not staffed with two regulated health professionals, have a second regulated health professional immediately available when procedures are being performed. The panel further clarified that an airway management course covering bag-valve-mask ventilation and supraglottic airway device insertion is sufficient (i.e. advanced airway management skills are not necessary).

Image guidance for spinal procedures: A criterion for the image guidance of all spinal procedures has been added. The panel also clarified that having both ultrasound and fluoroscopy in a facility is not necessary. However, facilities with only ultrasound will be required to have procedures in place for the timely referral of patients in the event that CT and/or fluoroscopy is indicated for proper visualization.

Multi-dose vials: The panel reaffirmed its position that the use of multi-dose vials be strongly discouraged and that their use be phased out over the next few years. A criterion for the use of multi-dose vials dedicated to a single patient has been added.

Other edits were made throughout for the purposes of clarification, guidance, and/or reorganization of the content.

The panel reconsidered the expectations for airway management and removed the requirements for succinylcholine and advanced airway equipment (e.g. larynscopes, endotracheal tubes) on the emergency cart.

Other edits were made throughout for the purposes of clarification, guidance, and/or reorganization of the content.

Edits were made throughout for the purposes of clarification, guidance, and/or reorganization of the content.

Next steps

When the consultation is complete and the standards are approved by the NHMSFAP Committee, community-based physicians who are currently performing procedural pain management will be notified regarding the process for applying for accreditation.

As of fall 2020, provisional accreditation will be required in order to perform PPM outside the hospital setting in community-based physician offices, practices and clinics.